Clinical application of pharyngeal high-resolution manometry in Ear, Nose and Throat (ENT) practice

Pharyngeal high-resolution manometry with impedance (P-HRM-I) is an emerging, ambulatory swallow assessment for patients with pharyngeal dysphagia. P-HRM-I provides quantifiable biomechanical metrics of the pharynx and upper oesophageal sphincter (UOS) and may inform clinical management. This paper describes the fundamentals of P-HRM-I assessment and analysis, with application to common dysphagia conditions presenting to an Otolaryngologist. The procedure for conducting a P-HRM-I assessment is detailed. The acquisition of contractility (pressure), timing, and bolus transit (impedance) is described. P-HRM-I analysis and interpretation is presented using metric definitions agreed by international expert consensus. The application of P-HRM-I is demonstrated in five cases presenting with globus sensation, cricopharyngeal bar, and dysphagia post-head and neck cancer treatment, with reference to a healthy swallow. P-HRM-I analysis and interpretation informing subsequent clinical management options is presented. The globus case demonstrates exclusion of UOS dysfunction or hypertonicity contributing to globus sensation. The cricopharyngeal bar cases demonstrate distinct UOS metrics differentiating those indicated for surgical management. Post-head and neck cancer treatment cases demonstrate the underlying biomechanical features contributing to dysphagia, whether localised at the pharynx or UOS to inform targeted treatment. This review showcases the application of P-HRM-I to extend current imaging swallowing assessments to guide the management of common Otolaryngology dysphagia presentations. Further clinical translation of this technology is recommended to optimise dysphagia management.